Great doctor, LEE Jong-wook: the first Korean to lead an international organization and the 6th World Health Organization director general

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Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2012 through June 2013 / 병원감염관리

BACKGROUND: The Korean Society for Nosocomial Infection Control (KOSNIC) ran a surveillance system, called as Korean Nosocomial Infections Surveillance (KONIS), since July 2006. Here, we report the annual data of the intensive care unit (ICU) module of the system from July 2012 through June 2013. METHODS: This is a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 161 ICUs in 91 hospitals using the KONIS system. The nosocomial infection (NI) rate was calculated as the number of infections per 1,000 patient days or device days. RESULTS: A total of 3,042 NIs were reported during the study period: 877 UTIs (854 cases were urinary catheter-associated), 1,272 BSIs (1,096 were central line-associated), and 893 PNEUs (526 cases were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.26 cases per 1,000 device days (95% confidence interval; 1.18-1.34) and urinary catheter utilization ratio was 0.78 (0.779-0.781). The rate of central line-associated BSIs was 2.57 (2.42-2.72) and the utilization ratio was 0.49 (0.489-0.491). The rate of ventilator-associated PNEUs was 1.64 (1.50-1.78) and the utilization ratio was 0.37 (0.369-0.371). The urinary catheter utilization ratio was lower in the ICUs of hospitals with 400-699 beds than in those of hospitals with more than 900 beds; nevertheless, CAUTIs were more common in the hospitals with 400-699 beds. The central line-associated BSI (CLABSI) rate was lower in the study period than in the previous period of July 2011-June 2012 [2.57 (2.42-2.72) vs. 3.01 (2.84-3.19)]. CONCLUSION: The CLABSI rates were lower in the study period than those in the previous years. CAUTIs were more common in the ICUs of hospitals with 400-699 beds than in those of larger hospitals.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012 / 병원감염관리

BACKGROUND: This article reports annual data of intensive care units (ICU) module of the Korean Nosocomial Infections Surveillance (KONIS) system from July 2011 through June 2012. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 143 ICUs in 81 hospitals using the KONIS system. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient days or device days. Asymptomatic bacteriuria was excluded on or after October 1, 2011. RESULTS: A total of 3,374 NIs were found during the study period: 1,356 UTIs (1,336 cases were urinary catheter-associated), 1,253 BSIs (1,091 were central line-associated), and 765 PNEUs (481 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 2.26 cases per 1,000 device-days (95% confidence interval, 2.14-2.39) and urinary catheter utilization ratio was 0.85 (0.849-0.851). The rate of central line-associated BSIs was 3.01 (2.84-3.19) and the utilization ratio was 0.52 (0.519-0.521). The rate of ventilator-associated PNEUs (VAPs) was 1.70 (1.56-1.86) and the utilization ratio was 0.40 (0.399-0.401). Ventilator and urinary catheter utilization ratios were lower in the ICUs of hospitals with 400-699 beds than those in hospitals with 700-899 beds or more than 900 beds. Nevertheless, VAPs and CAUTIs were more common in hospitals with 400-699 beds. CONCLUSION: Nosocomial infection rates were similar to the findings of those of the previous period, July 2010-July 2011. Implementation of proven infection-control strategies are needed, especially in the hospitals having fewer than 700 beds.

The Effects of Temperature on Heat-related Illness According to the Characteristics of Patients During the Summer of 2012 in the Republic of Korea / 예방의학회지

OBJECTIVES: This study was conducted to investigate the relationship between heat-related illnesses developed in the summer of 2012 and temperature. METHODS: The study analyzed data generated by a heat wave surveillance system operated by the Korea Centers for Disease Control and Prevention during the summer of 2012. The daily maximum temperature, average temperature, and maximum heat index were compared to identify the most suitable index for this study. A piecewise linear model was used to identify the threshold temperature and the relative risk (RR) above the threshold temperature according to patient characteristics and region. RESULTS: The total number of patients during the 3 months was 975. Of the three temperature indicators, the daily maximum temperature showed the best goodness of fit with the model. The RR of the total patient incidence was 1.691 (1.641 to 1.743) per 1degrees C after 31.2degrees C. The RR above the threshold temperature of women (1.822, 1.716 to 1.934) was greater than that of men (1.643, 1.587 to 1.701). The threshold temperature was the lowest in the age group of 20 to 64 (30.4degrees C), and the RR was the highest in the > or =65 age group (1.863, 1.755 to 1.978). The threshold temperature of the provinces (30.5degrees C) was lower than that of the metropolitan cities (32.2degrees C). Metropolitan cities at higher latitudes had a greater RR than other cities at lower latitudes. CONCLUSIONS: The influences of temperature on heat-related illnesses vary according to gender, age, and region. A surveillance system and public health program should reflect these factors in their implementation.

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2010 through June 2011 / 병원감염관리

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.

A Locally Acquired Falciparum Malaria via Nosocomial Transmission in Korea

A 57-year old man who was admitted to an emergency room of a tertiary hospital with hemoptysis developed malarial fever 19 days later and then died from severe falciparum malaria 2 days later. He had not traveled outside of Korea for over 30 years. Through intensive interviews and epidemiological surveys, we found that a foreign patient with a recent history of travel to Africa was transferred to the same hospital with severe falciparum malaria. We confirmed through molecular genotyping of the MSP-1 gene that Plasmodium falciparum genotypes of the 2 patients were identical. It is suggested that a breach of standard infection control precautions resulted in this P. falciparum transmission between 2 patients in a hospital environment. This is the first report of a nosocomial transmission of falciparum malaria in Korea.

Reporting of National Notifiable Infectious Diseases (NNIDs) and Related Characteristics / 한국역학회지

communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model. METHOD: We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%). RESULT: The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.4%, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians' reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (alpha=0.05). CONCLUSION: The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group II, Designated Group NNIDs.

Initial CD4+ T Cell Counts Analysis in Newly HIV-diagnosed Koreans

BACKGROUND: In spite of active HIV/AIDS control and managements, UNAIDS estimate that 40 million people were living worldwide with HIV at the end of 2001. In Korea, The member of HIV- infected adults are continuously growing. For improvement of HIV screening and prevention, we analyzed over times the relationship between the changes in initial CD4+ T cell counts of newly HIV- diagnosed adults, sex, and exposure route. METHODS: We selected 1011 newly HIV-diagnosed adults whose initial CD4+ T cell count was determined within 6 months of HIV diagnosis between 1990 and June, 2002. Based on CD4+ T cell counts, the selected people were grouped into 4 as follows: 700 cells/mm3. The relationship between initial CD4+ T cell counts, age, sex, and HIV risk category were studied by regression statistic methods. RESULTS: The median initial CD4+ T cell counts decreased over times (P<0.001). In each major group, over 50% of initial CD4+ T cell counts were below 350 cells/mm3. For homosexually infected adults, the median age did not statistically increase (P=0.062). However, in heterosexually infected adults, the median age increased throughout the time period examined (P<0.001) with an exception of female group (P=0.427). The multi-regression analyses revealed that older age (P<0.001) and male sex (P<0.001) were independently associated with lower initial CD4+ T cell counts, but not exposure group (P=0.483). For each year cohort of newly diagnosed adults, the median initial CD4+ T cell counts in subsequent years decreased until 1998 and then increased thereafter. CONCLUSION: These results show that a large proportion of HIV-infected adults are being diagnosed late in the course of HIV infection, particularly heterosexually infected male group. Therefore, we should continuously enforce screening, prevention and prompt diagnosis of high risk groups.

Initial CD4+ T Cell Counts Analysis in Newly HIV-diagnosed Koreans

BACKGROUND: In spite of active HIV/AIDS control and managements, UNAIDS estimate that 40 million people were living worldwide with HIV at the end of 2001. In Korea, The member of HIV- infected adults are continuously growing. For improvement of HIV screening and prevention, we analyzed over times the relationship between the changes in initial CD4+ T cell counts of newly HIV- diagnosed adults, sex, and exposure route. METHODS: We selected 1011 newly HIV-diagnosed adults whose initial CD4+ T cell count was determined within 6 months of HIV diagnosis between 1990 and June, 2002. Based on CD4+ T cell counts, the selected people were grouped into 4 as follows: 700 cells/mm3. The relationship between initial CD4+ T cell counts, age, sex, and HIV risk category were studied by regression statistic methods. RESULTS: The median initial CD4+ T cell counts decreased over times (P<0.001). In each major group, over 50% of initial CD4+ T cell counts were below 350 cells/mm3. For homosexually infected adults, the median age did not statistically increase (P=0.062). However, in heterosexually infected adults, the median age increased throughout the time period examined (P<0.001) with an exception of female group (P=0.427). The multi-regression analyses revealed that older age (P<0.001) and male sex (P<0.001) were independently associated with lower initial CD4+ T cell counts, but not exposure group (P=0.483). For each year cohort of newly diagnosed adults, the median initial CD4+ T cell counts in subsequent years decreased until 1998 and then increased thereafter. CONCLUSION: These results show that a large proportion of HIV-infected adults are being diagnosed late in the course of HIV infection, particularly heterosexually infected male group. Therefore, we should continuously enforce screening, prevention and prompt diagnosis of high risk groups.